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Friday, May 24, 2019

I Have Insurance - If The Real World Worked. . .

CP: Do we have insurance?
ME: You know we do.
MYSELF: What type, specifically?
CP: Good question.
ME: Home?
ME: Auto?
MYSELF: Of course.
CP: Homeowners?
ME: Medical? Dental? Vision? Prescription?
CP: Life? Professional?
MYSELF: Yes and Yes. . . Especially in this profession.
ME: What's your point?
CP: Have you ever had to use it?
ME: Yes.
MYSELF: I hand someone a card or give them the information from the card.
CP: What happens then?
ME: Usually they tell me an amount to pay or send me a bill.
CP: Okay. Then what of you do?
MYSELF: Pay it!
CP: When you're standing at the doctor's office, or the ER, or speaking with your auto or homeowners representative, you don't question anything?
ME: No. They give me an amount and I pay it. It's a fairly straightforward, seamless transaction.
CP: Then why is pharmacy different?
MYSELF: What's the number one quote we hear from patients at the counter when they are presented  their copays?
ME: I. Have. Insurance!
CP: Right. As if that will erase everything. POOF! Copay be gone!
MYSELF: And it matters not if their copay is $0.13 or $13.13 or $1300.00. I. HAVE. INSURANCE! is waved around as if summoning the magical copay phairy to erase the balance.
ME: You know what's worse than a patient at the counter looking you dead in the eye and saying "Insurance. Insurance! I have insurance"?
CP: Standing at the counter when presented with a copay and simply, slowly, uttering 3 syllables: "Good. R. X.".
MYSELF: Yeah. Speaking of magic incantations.
CP: I think from now on, when people's response is either "Insurance" or "GoodRx", I am going to reply with "Stay Golden, Pony Boy".
MYSELF: It will be worth it for the confused looks.
CP: Sorry, I thought we were just throwing random words and quotes at each other, like a rap battle. "You say insurance, I say a quote."
ME: "Insurance"
CP: "Now is the winter of our discontent."
MYSELF: "Insurance!"
CP: "Forty-two!"
ME: "Insurance!"
CP: "All this pain is an illusion."
ME: I think you lost them all by now.
CP: Well, negotiations were short.

Tuesday, May 21, 2019

More Phun With Dick And Jane

Jane is a pharmacist.
Dick is a patient. 

Jane: Hello. May I help you? 
Dick: Yes. I am here to <phone rings> pick up my prescription. 
Jane: And the name? 
Dick: <phone rings> Dick. 
Jane: Okay. Let me find that. 
Dick: <answers phone, loudly> "sorry, yeah, just picking up my prescription at the pharmacy. yeah, sorry, hold on, the pharmacy lady is back." 
Jane: I have a few things to review with you about your new medication. 
Dick: <yeah, sorry, hang on> Which one? 
Jane: Valtrex. 
Dick: What's it for? 
Jane: The Herp. 
Dick: Can't you see I'm on the phone? That's private. 
Jane: You know that just because the phone rings, it does not mean you need to answer it, right? You revoked HIPAA when you invited a third party into the conversation. 



Jane is a pharmacist. 
Dick is a patient. 

Dick: Hello? 
Jane: This is CP Jane calling from your pharmacy. 
Dick: Okay. What do you need? 
Jane: I am calling to see if you are going to pick up your medication that has been here for 10 days.
Dick: I. AM. AT. A. FUNERAL! You picked a fine time to bother me. Have you no shame? 
Jane: Sorry, my store phone didn't come with the missile guidance system that allows me to target everyone's location. Seriously though. Who takes a phone to a phuneral? Better yet, who ANSWERS a phone at a phuneral? You do realise that just because it rings, does not require you to answer it. 



Jane is a pharmacist. 
Dick is a patient. 

Jane: I have 3 prescriptions for you. 
Dick: Okay. <answers phone in car via bluetooth>
Jane: Your total is $5.29. 
Voice In Car Talking Over Radio Is Annoying: What do you want on your pizza?
Dick: <hands over card> Here you go. 
Jane: I like green olives and bacon. 
VICTORIA: Who was that?
Dick: The pharmacist. 
Jane: I like pizza. 
Dick; She was talking to me. 
Jane: I wasn't sure. Since you felt the need to answer while we engaged in a personal transaction, I thought this was a conference call. Maybe you'll drop me a slice. 
Dick: No. 
Jane: Okay. Well with your new cholesterol medication, you need to cut down on the bacon and meats and cheeses. Perhaps a sardine and avocado pizza would befit your diagnosis. 
Dick: Don't talk about my medication while I'm on the phone. 
Jane: Unlike you, I have an obligation to discuss this. In fact, I am required to discuss it with you. Next time the phone rings, consider not answering it. Texting would have avoided this. Seriously though, avocado and sardines. Try it. 


Sunday, May 19, 2019

Dick And Jane

Jane is a pharmacist.
Dick is a patient.

<at the drive-thru>

Jane: Hello. How may I help you today?
Dick: I need to pick up my prescription.
Jane: Okay, but first I'm going to have to ask you to put out your cigarette.
Dick: Why?
Jane: Well, there are 3 No Smoking signs clearly posted on my windows and the exterior wall.
Dick: So?
Jane: Some of our staff have asthma as well as allergies to smoke. The smoke also wafts through the air on the cross breeze and directly to my counter. We have patients in the store who have asthma, allergies, emphysema, and COPD and it can affect them.
Dick: So? I have COPD too.
Jane: I wonder why.


Monday, May 13, 2019

Beat The Clock

Why pharmacy is, and should not be, like a cooking show. (Or taking an exam.)
CP: Do you enjoy watching cooking shows?
ME: You know we do.
MYSELF: Top Chef, Cutthroat Kitchen, Worst Cooks, we love them all!
CP: How are they like the current practise of pharmacy?
ME: We all yell "order up!"?
MYSELF: We take things from the pantry and assemble them into finished products?
CP: I suppose that works. Not really where I was going with this, but . . .
ME: Oooh. Oooh. I know.
CP: Yes?
ME: We have timed challenges!
MYSELF: Dorque.
CP: Closer. In the cooking shows, there is a challenge. The challenge is indeed time. There is usually a sabotage or wrinkle thrown in and the contestants, from seasoned chefs to first-time kitchen visitors,  must negotiate these as well as completing the dish.
MYSELF: Yeah. They always seem to just throw something on the plate and often forget the sauce or the mushrooms.
CP: Even though they seemingly have enough time, things don't always work out in their favour and sacrifices have to be made.
ME: Good thing we don't work under those conditions.
MYSELF: <pssst> I think that's the point of this post. These are exactly the same conditions.
CP: Quite. Whereas the judges on the show may complain their chicken is undercooked, the potatoes are hard, or the one judge didn't get the crispy kale on her plate, these conditions will only result in a bad score. These results in pharmacy can be catastrophic and life-threatening.
ME: I am appalled! These are contests that push the contestants to work under pressure to create beautiful, delicious plates of food; for a prize and for the enjoyment of the public living vicariously through them and the judges.
MYSELF: It's chaos. For entertainment. Not exactly what one wants for their healthcare.
CP: If I weren't living it every day, I'd expect a reality TV host to jump out at any moment and coach me on how to behave. In fact, I assume they are taking notes from the minds of pharmacy CEOs:
give them normal work (Rx's to fill).
now time them
now cut that time in half and promise the public that new time
add in phone calls (answering)
remove tech help to handle the phone calls
add in a drive thru
remove tech help from drive thru
add in more work (check other stores' work)
check emails
make them respond to emails about not meeting times
add in phone calls (making)
remove RPh overlap
remove tech help
add in more work (conference calls to talk about the work not getting done)
remove food and drink and sanity breaks
add in complaints
make them answer complaints
add in metrics they can't meet
add in quotas
add in vaccinations
add in sales pitches (sell stupid crap from the "as seen on TV section")
have them juggle bottles while counting
have them counsel patients while twirling a baton
add in a person to come yell at them every 12 minutes

ME: WOW! That'd make a great show. I'd watch that.
ME: You can juggle?
CP: Yes.

Friday, May 10, 2019

Kim Kardashian

CP: I have an Rx ready for a Miss Carrion.
KK: That's not how it's pronounced. 
CP: It's spelled Kar-Ian. Carrion. 
KK: The dash is not silent. 
CP: So your name is. . . 
KK: Kar DASH ian. 


Wednesday, May 8, 2019

What's In A Name?

Lots of thought.
Or no thought.
As parents, there is an obligation on you when naming your child.
Make sure he/she is not going to have to deal with a life of misfortune thanks to your decision. (Marlana backwards? Anyone?)
(And let us keep in mind the poor souls with longer-and-more-complicated-than-necessary spellings who are forced to complete bubble tests. While they are still bubbling in their names, half the class have completed the exam.)

For those of you with cute, peculiar names or with atypical spellings, keep one thing in mind: In life, there is no one who is responsible for your name except your parent(s). Especially not the pharmacy staff.
Hate your name? Change it.
Hate the spelling? Change it.
Hate having to explain to everyone with whom you interact how to spell or pronounce your name? Change it.
Or, better yet, embrace it. It's beautiful. Just like you.
We know it's not your fault, but it IS your name. It's not my name.
If you know you have a unique spelling, please accept the fact and help us.
(Yes, there are lots of photos of Starbucks cups with beautiful attempts at names but I'd rather put it in to the computer correctly and be able to find you when needed.)

If you are a Thom instead of a Tom, tell us.
Same goes for Theresa or Teresa.
Alyx and Alex and Alixx?
Allison, Alison, Alyson.
Larry or Lawrence or Laurence?
Geri or Gerri or Jeri or Jerri or any of those with a "y"?
Don't even get me started on the K v C names-
Kathy/Cathy, Katherine, Kathryn, Katharyn, et al. (Same goes for Kaitlynn)
Kris, Chris, Criss, Khris?
Cindi, Cindy, Cyndy?
Caryn, Carin? Karen?

Seriously. I could do this all day. You get it. And I know people will add some of their favourites. Or favorites.

The point is, make life easier on everyone.
When picking up at the pharmacy, or anywhere you need to give your name, just tell us "it's-Jon-with-no-H". Save us all some grief and especially that awkward moment where we have to stare at you because we can't seem to locate you in the system. I can't possibly process all the permutations of  Kaitie, or Caitie, Katey, or Caity, or . . . ad infinitum.

If you have to tell me how to spell your name, this is not the first time you have encountered this.
Be polite.
"Erik with a K" is nice.
(Also, please pick one name and stick with it. "The doctor has me as Taylor but I go by Lyn with one N here at the pharmacy but my real name is TaQLynn with 2 N's and a silent Q. It's pronounced TAY LIN.")

Again, don't get mad because we do not know how to spell or pronounce your name. Take a second, spell it, pronounce it and we may remember it.
Yes, you are unique, just like everyone else.
You live with your name and I with mine.
Our interactions are limited to minutes per month and the name exchange is but seconds of this time. It is ephemeral and quickly forgotten, as when you provide your date of birth.


Monday, May 6, 2019

Good Rx - Good Phor Patients, Bad Phor Pharmacists

I was on a Netflix or Hulu binge recently and saw a GoodRx ad. Normally my blood pressure elevates only slightly during these ads but this one made my blood boil.
Phine. GoodRx helps patients save money. Not against that.
Phine. If pharmacies want insurance contracts we have to accept GoodRx. K.
My issue with this particular ad was in the way the actualisation of the savings was portrayed. People believe what they see with their eyes, not what knowledgeable, credible, professional people tell them. This means that after watching this ad, patients will make the assumption that the scenario portrayed in the ad is a mirror of real world practises.
It's not.
Phar phrom it.

What happened in the ad to ruffle your feathers, CP?
The patient approached the pharmacy counter and was told/shown a price by the pharmacist of $67.00. As the patient's look of shock took root, she realised she had a phone which she pulled out, found a price on GoodRx, then showed it to the pharmacist. The pharmacist, at the register, waved the phone in front of the register and the price on the screen magically dropped to $8.90.

Did you see it?
It instantly changed from $67.00 to $8.90. . . AT. THE. REGISTER!
(Yes. I realise it is a 30 second commercial. This does, however, reinforce the false belief that changing a copay and getting the discount is like handing a cashier a coupon at the grocery.) #ThatsNotHowItWorks!

Why is this bad, CP?
First, it trivialises what we do.
Second, it encourages bad behaviour in patients when it doesn't work exactly as shown in the commercial.

GoodRx is NOT a credit card.
GoodRx is NOT a register coupon.
In order to use the GoodRx discount (or any other pharmacy discount card, including manufacturer coupons) we have to change how we billed the prescription. This means we must edit the prescription and either add the new coupon or reverse the claim to your insurance and bill only the GoodRx plan. This is completed in the data entry system, not the register.
Once completed, the pharmacist must then reverify all of the information, including checking the prescription and the medication dispensed. (Sometimes the GoodRx coupons are for different quantities and now we must change what we dispensed.)

How does it work in reality, CP?
Patients can expect a wait.
Can I redo the prescription in 5 minutes? Sure.
Should they expect it each time? No.
Are they the only person who needs something done right now? Definitely not.
Their prescription gets put in line along with everyone else's.

How can they expedite the process?
Call ahead.
Call for the price BEFORE coming to the pharmacy.
When you check GoodRx online, call back with the billing information BEFORE coming to my counter.
This will allow me to process it when I can and run a smoother workflow in my store.
It's also not fair to other patients waiting on prescriptions for you to expect yours to be redone ahead of theirs. Sure it was finished, but you changed the completed order. (Imagine finishing placing your order at Arby's, sliding on down to the pickup window then deciding to change your order. You can't just sidle on back to the order window, cut in front of the line, and expect the staff to redo your order ahead of those waiting to place orders. Or maybe you do expect that which is why you suck.)

Either way, please complain to GoodRx that even though they have cheapened prescriptions for patients, they don't need to cheapen our profession along with it. We can handle that quite well on our own, TYVM.

Tuesday, April 23, 2019

A(nother Holi)Day In The Life

CP: Thanks for calling CP's Pill Palace. This is CP, Paladin of Pills, how may I help you?
Worker Of Miracles Anxiously Needy: I need a dose of my Xarelto.
CP: I see you are out of refills. I can fax your doctor.
WOMAN: I'm out! Don't you know I have afib?
CP: Yes. Yes, I can infer such a diagnosis from the medication. And?
WOMAN: Well I need it.
CP: Were it so important to you, this afib diagnosis, you would have been more proactive, right?
WOMAN: I'm going to die.
CP: Eventually, yes. But, in the words of Syrio Forel, "not today". If you are that concerned, call your office. Or go to the ER.
WOMAN: It's Easter!
CP: Didn't stop you from calling me. Besides, your refill expired in December. We last refilled it in October for 3 months. How did you make a 3 month supply last 6 months?
WOMAN: I just took my last one last night.
CP: He is Indeed Risen! It's an Easter miracle. You made a 3 month supply last 6 months. Impressive. Do it again and you'll have enough for the weekend.
WOMAN: Well why didn't you call me?
CP: And say what?
WOMAN: To refill it.
CP: We probably did. Last year. When it was due. If you have a surplus of medication, I can't see that.
WOMAN: Well something's wrong here. What are you going to do?
CP: Repeat my earlier comment, a little firmer this time: Call your prescriber. They have answering services and on call prescribers for a reason.

<2 hours later>

CP: We just received your prescription. You may come to retrieve it at your earliest convenience. We are here until 3pm today.

<WOMAN comes in to pick up>

WOMAN: Am I on that courtesy refill thingy?
CP: Yes.
WOMAN: I still don't understand why you let me run out of medication.
CP: Well, simply put, we call when it's due. Which is usually about 10 days early on a 90 days supply. If you don't want it, don't need it, or don't pick it up, it goes back in stock and we wait to hear from you.
WOMAN: Well something is wrong here. I'm very scared.
CP: I'm sorry. What? You're scared? Of what?
WOMAN: That your system let me run out of medication.
CP: How is it that you made it to 75 years old? What did you do before pharmacies did everything except actually take your medications for you? Or anything else for that matter. Your car must constantly run out of gas and your refrigerator must always be empty since no one is there to tell you they need refilled.
WOMAN: I guess I'll have to go home and figure out what to do now.
CP: You do that. But make an appointment with the prescriber. They only approved a one month supply. Happy Easter!